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By LAURA LANDRO

The
swine-flu pandemic is creating unexpected problems for the nation's
blood supply—shrinking the number of blood donors and raising questions
about whether the flu can be spread through a transfusion.

A number of blood centers are reporting an unusual drop in
collections because too many potential donors are sick with the H1N1
virus, or swine flu. Some blood drives in high schools and corporate
offices have had to be scaled back or canceled because of high levels
of absenteeism.

Another
problem: Some centers say a growing number of donors are calling a day
or two after giving blood to say they've come down with flu-like
symptoms, forcing the centers to dispose of the blood as part of
government regulations. Researchers in a government-funded study are
testing samples of these donors' blood for viremia, the medical term
for virus in the blood.

Unlike infectious diseases such as HIV/AIDS, hepatitis C and West
Nile virus, colds and flu aren't believed to be transmitted by blood.
But some studies indicate that more virulent strains can be present in
the blood before flu symptoms show up. "When you get into strains that
are pandemic, the rules don't necessarily apply," says Matthew
Kuehnert, director of the Office of Blood, Organ and other Tissue
Safety at the Centers for Disease Control and Prevention.

So far, medical officials say there is enough blood to comfortably
supply the 15 million units used annually in trauma units, operating
rooms and elsewhere. But blood centers have begun working with the
federal government and hospitals to put emergency planning measures in
place, such as allocating blood only to the sickest patients, should
the pandemic worsen or return in a more virulent form next spring.

"We are very worried about the impact of swine flu," says Marsha
Springel, donor resources manager at the Miller-Keystone Blood Center
in Bethlehem, Pa., which serves eight counties in Pennsylvania and New
Jersey. "Right now we have an ample supply, but if this hits as big as
they are predicting, we will lose the schools, and they are a large
proportion of our donor base," she says.

At
one high-school drive last week, high absenteeism meant Miller-Keystone
collected just 33 units of blood, instead of the 70 to 80 units they
had expected. And over Halloween weekend, a local ski club had to
cancel a drive because so many members were ill.

As of last week, 48 states reported widespread influenza activity,
with almost all the illnesses identified so far as swine flu, according
to the CDC. While visits to doctors for flu-like illnesses decreased
slightly last week after four consecutive weeks of sharp increases,
they are at much higher levels than what is expected at this time of
year. Parts of the country are still seeing sharp increases in activity
and it is possible that illness rates could rise again.

At donor centers, blood is separated into red blood cells, platelets
and plasma, then undergoes 14 tests, including 11 for infectious agents
such as HIV to ensure its safety. Blood is then labeled by type, stored
at appropriate temperatures, and distributed to hospitals as needed.
Centers are concerned that the supply they keep on hand—typically three
to five days' worth of blood—could quickly become stretched if more
donors fall ill.

Declining Turnout

America's Blood Centers, an association
of independent facilities that combined collect about half the U.S.
blood supply, says that 27% of its member centers are reporting a
decrease in overall collections due to swine flu. Nearly a quarter of
the centers reported that collections have dropped at high schools,
which have been one of the fastest-growing sources of blood donations
in recent years as more states allow students as young as 16 to donate.
And more than 15% of centers reported declines in blood collections
from colleges and from corporations, where layoffs and plant closings
have hurt blood drives. Association members reported that the declines
are manageable.

At
Lane Memorial Blood Bank in Eugene, Ore., which supplies three
hospitals in the area, Executive Director Doug Engel says absenteeism
rates of up to 35% at local high schools have put a dent in
collections. The blood bank is now calling schools and companies that
sponsor drives a few days ahead to check on absentee rates, and may
send a mobile van instead of setting up drives in high-school
gymnasiums to save costs.

Partly offsetting the reduced collections is lower blood demand as
more people put off costly elective surgeries due to the tough economy,
says Richard Benjamin, medical director of the Red Cross, which
supplies about 43% of the nation's blood. But a looming worry is the
upcoming holiday season, when it is traditionally harder to recruit
donors. "If swine flu continues on its path, disrupting blood
collections during that period, we are really going to need more
donors," Dr. Benjamin says. The Red Cross and its local chapters are
turning to social-networking sites such as Facebook and Twitter to get
the word out about the need for blood.

Medical experts generally don't believe colds and flu can be
transmitted by blood, and no case of seasonal influenza transmitted by
blood has ever been reported in the U.S. But there also has been little
active surveillance for flu in the blood supply.

The National Institutes of Health since the late 1980s has funded
studies of blood safety through a program known as the Retrovirus
Epidemiology Donor Study, or Reds, to determine the prevalence of HIV
among blood donors and the risks of transmitting HIV and other viruses
via transfusions. As part of a second phase of that study, researchers
in 2006 began examining whether influenza virus could be detected in
blood. Philip Norris, associate director of the Blood Systems Research
Institute in San Francisco, and a lead investigator on the project,
says testing of hundreds of blood donors at risk for seasonal influenza
hasn't revealed any evidence of influenza virus in the blood. He says
his group is repeating the study with new blood samples "in case our
assumption that H1N1 will behave like seasonal influenza is wrong."

Dumping Blood

Food
and Drug Administration regulations require blood centers to turn away
would-be donors who have any symptoms of illness. And any donor who
falls ill shortly after giving blood is asked to notify the center
where they donated so their blood can be removed from inventory. So
far, the swine flu has turned out to be less infectious than medical
experts at first feared. Still, because many patients who get blood
transfusions have weak immune systems, a flu infection transmitted
through the blood could be extremely dangerous, increasing their risk
of death.

The FDA says the benefits of a transfusion where medically necessary
far outweigh the risks, including any "theoretical" risk of swine-flu
transmission through blood or blood products. But an FDA spokeswoman
says the agency will continue to review any new scientific information
about the potential risks and may revise its recommendations "as
appropriate."

When a new threat is discovered, the FDA has shown it can act
quickly. In 2003, a test for West Nile virus was developed and approved
by the FDA that identified nearly 1,000 blood donors with the infection
before their donations entered the blood supply.

Researchers are studying other risks of infection and harm from
blood transfusion, such as unexpected adverse reactions to donated
blood. Patients concerned about such risk can ask about donating their
own blood before surgery, or having surgeons recycle any blood that may
be lost during their procedures.

"Assuming the swine flu virus doesn't begin to look more virulent,
we hope we can look back at H1N1 in 2009 as an important planning
exercise for the future to see where our vulnerabilities lie," says
Louis Katz, executive vice president, medical affairs, of the
Mississippi Valley Regional Blood Center in Davenport, Iowa, and chair
of a national task force on pandemic flu and the blood supply.

Meanwhile, along with screening out obviously ill patients, blood
centers are taking extra hand hygiene and infection-prevention
precautions to "create as safe an environment for blood donors as
possible," Dr. Katz says. "The most important message is that people
still need to get out there and donate blood."

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